Review
Impact of electronic healthcare-associated infection surveillance software on infection prevention resources: a systematic review of the literature

https://doi.org/10.1016/j.jhin.2017.09.002Get rights and content

Summary

Background

Surveillance of healthcare-associated infections is fundamental for infection prevention. The methods and practices for surveillance have evolved as technology becomes more advanced. The availability of electronic surveillance software (ESS) has increased, and yet adoption of ESS is slow. It is argued that ESS delivers savings through automation, particularly in terms of human resourcing and infection prevention (IP) staff time.

Aim

To describe the findings of a systematic review on the impact of ESS on IP resources.

Methods

A systematic search was conducted of electronic databases Medline and the Cumulative Index to Nursing and Allied Health Literature published between January 1st, 2006 and December 31st, 2016 with analysis using the Newcastle–Ottawa Scale.

Findings

In all, 2832 articles were reviewed, of which 16 studies met the inclusion criteria. IP resources were identified as time undertaken on surveillance. A reduction in IP staff time to undertake surveillance was demonstrated in 13 studies. The reduction proportion ranged from 12.5% to 98.4% (mean: 73.9%). The remaining three did not allow for any estimation of the effect in terms of IP staff time. None of the studies demonstrated an increase in IP staff time.

Conclusion

The results of this review demonstrate that adopting ESS yields considerable dividends in IP staff time relating to data collection and case ascertainment while maintaining high levels of sensitivity and specificity. This has the potential to enable reinvestment into other components of IP to maximize efficient use of scarce IP resources.

Introduction

Healthcare-associated infections (HCAIs) are the most frequent complications affecting patients in healthcare facilities, resulting in significant morbidity and mortality [1]. They are largely preventable but the emergence of multidrug-resistant organisms, increasing numbers of immunocompromised patients, and more widely used invasive procedures and medical implantations make prevention challenging [2], [3], [4]. Key to preventing and controlling HCAIs is their identification and reporting through standardized classification, which comprises a major component of surveillance. Surveillance is a fundamental tool to successful infection prevention and control programmes [5]. The purpose of HCAI surveillance is to provide quality data that can act as an effective monitoring and alert system and reduce the incidence of preventable infections [6], [7]. Effective surveillance systems deliver information that can be used to inform decisions.

Surveillance is a cyclical process encompassing recognition of an event, data collection, analysis, interpretation and dissemination [8]. Surveillance of HCAIs is a highly resource-intensive activity, with ‘traditional’ surveillance methods involving the infection prevention (IP) staff in exclusively manual data collection processes that are time-consuming, resource intensive, and generate data of variable quality [9], [10], [11], [12]. In the USA it has been reported that up to 45% of IP staff time is dedicated to undertaking surveillance [13]. A recent Australian study identified that IP staff spend 36% of their time on surveillance [14]. The proportion of overall surveillance time spent on data collection has not been identified. It is also suggested that the annual staffing costs of IP staff (nursing component) in Australian hospitals could be AU$100 million [15]. This represents significant resources devoted to HCAI surveillance.

Emerging information technologies were first reported in the assistance of identifying HCAIs three decades ago [16]. It is reported that between 23% and 56% of facilities in the USA have electronic surveillance software (ESS) [17], [18], [19]. Studies have demonstrated that automation and the use of ESS result in improved data accuracy and sensitivity when compared to traditional methods [20], [21]. This is particularly important with the increasing requirements for public reporting of HCAIs and their use for performance measurement associated with financial penalties. It is also claimed that ESS can assist IP staff with surveillance by decreasing the burden of data collection, resulting in significant time savings [5]. Despite widespread availability, Hebden notes that the adoption of ESS is slow, and suggests that this may be due to a lack of understanding the barriers to implementing ESS [16].

In the healthcare environment of precious financial and human resources, decision-makers should be provided with evidence to demonstrate benefits of new technologies. This paper describes the findings of a systematic review on the impact of ESS on IP resources.

Section snippets

Protocol and registration

The protocol for this review is registered with the International prospective register of systematic reviews (PROSPERO; http://www.crd.york.ac.uk/prospero/; registration number: CRD42016052998). Ethics approval was not required as this review synthesized data from published studies.

Search strategy

A systematic search was conducted. Electronic databases Medline (PubMed) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for articles published between January 1st, 2006 and

Study selection

The initial search identified 3584 potential articles. After duplicates were removed, 2832 abstracts from articles were reviewed. In all, 147 plus two additional articles identified through hand-searching were deemed suitable for a full text review. Sixteen studies (0.45%) were deemed to meet the eligibility criteria and were included in the full text review. The PRISMA flow chart describing the papers identified from the search strategy is demonstrated in Figure 1.

Risk of bias

When studies were assessed

Discussion

This paper describes the findings of a systematic review on the impact of ESS on infection prevention and control resources. Thirteen studies included in this review demonstrated a reduction in IP staff time. The remaining three did not allow for any estimation of the effect in terms of IP staff time [38], [36], [37]. Nine studies reported sensitivity and specificity of the ESS which remained high. None of the studies demonstrated an increase in IP staff time to administer ESS in their setting.

Conflict of interest statement

B.M., P.R., and D.M. were authors on some of the papers included in this review. The decision to include/exclude studies which they authored, in addition to a risk of bias assessment, was made independently by other members of the research team. All data extracted from these studies were independently checked by other members of the research team. The authors have no other conflicts to declare.

Funding sources

Funding to support this study was provided by Avondale College of Higher Education, via a summer scholarship grant.

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